We propose to create a learning laboratory for patient safety in primary care. The Partnership in Resilience for Medication Safety Learning Lab (PROMIS Lab) redesigns primary care work systems to address multiple types of medication related harms among older adults through collaborating with clinics and patients, including those in low socio-economic status. Preventable patient harms from medications such as opioids are significant threats to patient safety in ambulatory and community settings and contributed 700,000 emergency department visits each year. More than a third of community-dwelling 65 years or older adults take 5 or more prescription medications. In ambulatory and community settings, more so than in inpatient settings, medication safety is shaped by interactions among patient/family and different professionals across locations. The PROMIS Lab develops much needed strategies in primary care where professionals are in a unique position to partner with patients and community caregivers to reduce risks of medication-related preventable harms, such as polypharmacy and inaccurate medication information, and to cope with setbacks and disturbances that threaten safety. Our team is uniquely positioned to take systems engineering approach to partnership building. We will work with two ?in-situ lab? clinics from a practice-based research network for problem analysis, design and evaluation. The PROMIS Lab includes community partners to involve older adults and their caregivers in design cycles, and a network of informant clinics for observations and learning. We will conduct design and tests a simulated outpatient care suite. Patients and home caregivers frequently encounter disturbances induced by healthcare system, community, family and patient factors. The PROMIS Lab innovates solutions in patient safety in an ?open? community environment by focusing on enhancing capacity for resilient actions to dynamically forestall, mitigate, and recover from failures and in achieving success in medication safety in community settings. We will use the well-known systems engineering approach to achieve its goals: problem analysis (Aim1), design and development (Aim 2), implementation and evaluation (Aim 3). Aim #1. Identify and define primary care work system design requirements to address commonly occurring medication related safety hazards and to enable resilient performance through partnership. Aim #2. Improve the value of primary care services using work system design strategies, such as informational tools, task redesign, and space layout, to enable and build capacity for resilient performance. Aim #3. Implement and evaluate redesign work system components at 2 primary care clinics. The PROMIS Lab's long term impact will be insights and innovative, yet practical tools, design guidelines, and collaboration support strategies for teamwork beyond clinic walls, to effectively partner with clinicians, pharmacists, patients and families to reduce inappropriate opioid use and other common high-risk dangerous medication practices. We aim at resilience to health care delivery challenges in vulnerable populations and the clinicians caring for them.